Citation Nr: 0201520
Decision Date: 02/14/02 Archive Date: 02/20/02
DOCKET NO. 01-04 416 ) DATE
)
)
On appeal from the
Department of Veterans Affairs (VA) Regional Office (RO)
in Jackson, Mississippi
THE ISSUE
Entitlement to a rating higher than 20 percent for
hemorrhoids.
REPRESENTATION
Appellant represented by: Paralyzed Veterans of America,
Inc.
ATTORNEY FOR THE BOARD
G. Zills, Associate Counsel
INTRODUCTION
The veteran served on active duty from July 1972 to November
1973.
This case comes before the Board of Veterans' Appeals (Board)
from an August 2000 RO decision which reduced the rating for
hemorrhoids from 20 percent to 10 percent. The RO
subsequently restored the 20 percent rating for hemorrhoids.
The veteran has continued to appeal for a rating higher than
20 percent for hemorrhoids.
FINDINGS OF FACT
The veteran's internal and external hemorrhoids include
manifestations of excessive redundant tissue, tenderness, and
a subjective history of bleeding with no evidence of bleeding
on recent examination.
CONCLUSION OF LAW
The veteran's hemorrhoids are no more than 20 percent
disabling. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R.
§ 4.114, Diagnostic Code 7336 (2001).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
Factual Background
The veteran served on active duty from July 1972 to November
1973. His service medical records show that he was treated
for hemorrhoids in November 1972 and March 1973. The October
1973 service separation examination was negative for
hemorrhoids.
The RO granted service connection for hemorrhoids in November
1973, assigning a noncompensable rating. In April 1987, the
RO increased the hemorrhoid rating to 10 percent. In May
1994, the RO increased the hemorrhoid rating to 20 percent.
VA outpatient records from 1999 to early 2000 contain
isolated references to a history of hemorrhoids, although
during this time the veteran was treated for unrelated
conditions.
The veteran filed his current claim for an increased rating
for his hemorrhoids in April 2000.
VA medical records show the veteran was seen in the
rheumatology clinic in April 2000 with a chief complaint of
multiple joint pain, and he also complained of diarrhea
during the past few months, abdominal pain, and blood in his
stools. The impression was seronegative spondyloarthropathy.
A gastrorintestinal consultation was recommended for possible
inflammatory bowel disease.
In May 2000, the veteran was given a VA rectum and anus
examination. He reported that he had internal and external
hemorrhoids, and had occasional bleeding and itching. He
said he had hygiene difficulty as a result of the external
hemorrhoids, and stated that he wore tissues or a pad to keep
soilage from becoming a problem. He further stated that he
used Preparation H for treatment. On objective examination,
the examiner found two external hemorrhoids, which were not
inflamed and non-tender. Internal examination was very
tender with several engorged internal hemorrhoids revealed.
There was no blood upon examination, and rectal tone was
normal. No fissures or ulcerations were observed.
In June 2000, the RO proposed a reduction in the hemorrhoid
rating from 20 percent to 10 percent based upon improvement
in the veteran's condition. In August 2000, the RO reduced
the hemorrhoid rating to 10 percent, effective November 1,
2000.
The veteran filed his substantive appeal in April 2001,
asserting persistent bleeding and itching and the presence of
blood in his stool.
In May 2001, the veteran was given an additional VA rectum
and anus examination. He said he had hemorrhoids, that he
had bleeding associated with defecation two to three times
per week, and that he experienced rectal pain and itching.
He stated that he used Preparation H and suppositories for
treatment, and that he wore tissues following defecation
because of fecal soilage. He also indicated that he had
never had hemorrhoid surgery. Physical examination showed
redundant tissue externally, with no inflammation at the time
of examination. Internally, there was tenderness with
varicosities, and no evidence of bleeding. The examiner's
impression was both internal and external hemorrhoids. It
was noted that the veteran's rectal tone was normal. The
examiner also indicated that the amount of redundant tissue
present would create difficulty with cleansing, and therefore
fecal soilage would be a problem. A complete blood count
study was ordered, and laboratory results included slightly
low results for red blood cells, white blood cells,
hemoglobin, and hematocrit.
In July 2001, the RO restored the previous 20 percent rating
for hemorrhoids, effective November 1, 2000, the date from
which the rating had been reduced.
The veteran continued to appeal for a rating higher than 20
percent for hemorrhoids. In written argument in October and
November 2001, his representative noted that the 20 percent
rating was the maximum for hemorrhoids under Diagnostic Code
7336. It was argued, however, that in light of evidence of
soiling, an additional rating or alternative rating at a
higher level was warranted under Diagnostic Code 7334 for
prolapse of the rectum.
Analysis
The veteran seeks a rating higher than 20 percent for his
hemorrhoids. The file shows that through correspondence, the
rating decision, the statement of the case, and the
supplemental statement of the case, the veteran has been
notified of the evidence necessary to substantiate his claim.
Relevant medical records have been obtained and VA
examinations have been given. The Board finds that the
notice and duty to assist provisions of the law have been
satisfied. 38 U.S.C.A. §§ 5103, 5103A (West Supp. 2001)
(Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475,
114 Stat. 2096 (2000)); 66 Fed. Reg. 45,620, 45,630 (Aug. 29,
2001) (to be codified as amended at 38 C.F.R. § 3.159).
When rating the veteran's service-connected disability, the
entire medical history must be borne in mind. Schafrath v.
Derwinski, 1 Vet. App. 589 (1991). However, it is the more
recent evidence which is generally the most relevant in an
increased rating claim, as the present level of disability is
of primary concern. Francisco v. Brown, 7 Vet. App. 55
(1994).
Disability evaluations are determined by the application of a
schedule of ratings which is based on average impairment of
earning capacity. Separate diagnostic codes identify the
various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4.
External or internal hemorrhoids are rated as 0 percent when
they are mild or moderate. A 10 percent rating is assigned
when they are large or thrombotic, irreducible, with
excessive redundant tissue, evidencing frequent recurrences.
A maximum 20 percent rating is assigned with persistent
bleeding and with secondary anemia, or with fissures.
38 C.F.R. § 4.114, Diagnostic Code 7336.
The recent medical evidence, including two VA examinations,
shows the veteran has internal and external hemorrhoids, with
manifestations of excessive redundant tissue, tenderness, and
a subjective history of bleeding but no evidence of bleeding
on recent examination. Fissures were not noted on the recent
examinations. There has been no medical assessment of anemia
secondary to hemorrhoids, although the Board notes the
findings on the complete blood count at the last examination
raise a question of anemia. Assuming there is secondary
anemia from the hemorroids, such is one of the criteria for a
20 percent rating.
An increased rating is not available under Diagnostic Code
7336 for hemorrhoids, as the veteran is already rated at the
maximum amount of 20 percent allowed under that code.
The veteran's representative, noting references to soiled
underwear, has argued that an additional or alternative
higher rating is warranted under Diagnostic Code 7334 which
pertains to prolapse of the rectum. However, the medical
evidence shows no prolapse of the veteran's rectum, from
hemorroids or from any other cause. The recent VA
examinations noted normal rectal tone. Reference at the
examinations to the veteran's report of soiled underwear
pertains to his difficulty in cleansing/wiping himself after
a bowel movement due to excessive redundant tissue; such does
not refer to impairment of sphincter control or rectal
leakage. The excessive redundant tissue is one of the
criteria for a 10 percent rating under Code 7336 for
hemorroids. In any event, there is no prolapsed rectum
associated with the hemorroid condition, and a rating under
Code 7334 for rectal prolapse is not in order.
As noted, the veteran is receiving the maximum 20 percent
schedular rating for hemorroids. The Board does not have the
authority to assign a higher extraschedular rating, under
38 C.F.R. § 3.321(b)(1), in the first instance, and under the
circumstances of this case there is no basis to refer the
matter to designated VA officials for consideration of an
extraschedular rating. Bagwell v. Brown, 9 Vet.App. 337
(1996). Extraschedular ratings under 38 C.F.R. § 3.321(b)(1)
are limited to cases in which there is an exceptional or
unusual disability picture with such related factors as
marked interference with employment or frequent periods of
hospitalization as to render impractical the application of
the regular schedular rating standards. Such factors simply
do not appear in the present case, and the schedular 20
percent rating which has been assigned adequately compensates
the veteran for the industrial impairment related to his
hemorroids. See 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321(a),
4.1.
As the preponderance of the evidence is against the claim for
a higher rating for hemorrhoids, the benefit-of-the-doubt
rule does not apply, and the claim must be denied.
38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet.App. 49
(1990).
ORDER
A higher rating for hemorrhoids is denied.
L. W. TOBIN
Member, Board of Veterans' Appeals